Don't Be Afraid to Change (Your Practice Policies)

The only thing that remains constant in the universe, is change. — Heraclitus

I don't know if our good friend, the philosopher, knew it at the time, but he must have been referring to health care. After 31 years in the profession and seeing my parents go through all the changes in chiropractic from 1967 until I started practice in 1985 to present, I am convinced that things are never bad or good; just different.

The degree to which we learn to adapt will determine if we barely survive or thrive. And there's no better place to begin that adaptation, that change process, than with your compliance and financial policies.

Don't Avoid Change (Especially When You Know You Need It)

I recently attended a state association meeting and was talking to one of the doctors at our booth. He sat through a presentation on the rules and regulations regarding financial policies, and the importance of having a simple one that helps minimize the risks of complaints, audits, fines and penalties related to dual fee schedules, improper time-of-service discounts, inducement violations, anti-kickback violations and false claims. He got it. He understood it.

But when we discussed taking next steps to help him manage these risks, his response was a bit perplexing. To paraphrase, he said, "I'll have to talk to my staff to see how they feel about it and run it by my patients."

Too often, we know what we need to do, but become paralyzed when it comes to making change out of fear of what the staff will think or what a particular patient will think. There is no one who appreciates the input of staff more than me, but at the end of the day, I am responsible for making decisions and changes that are in the best interest of my patients, my practice, my staff, the profession and finally, me personally. And yes, I do look through that lens in that order.

When it comes to making decisions about changing the way we run the practice or any business, we must gather the data, weigh the input and make the decision. It's not always easy, but it is always the right thing to do.

Necessary Changes: A Practical Example

Confession is good for the soul, so here is mine. I recently had to make a decision about our staff responding to emails and texts "after hours." This has been a routine practice and just part of who we are as a team, always attempting to be first responders to problems or issues that come up – whether they occur during normal business hours or after hours, or even on the weekends.

While that seems like an admirable attribute, the reality is that I had to make a change because of risk management issues. So, what is the risk? It's the one disgruntled employee who files a complaint with the Department of Labor over not being paid overtime or for all of their time, even if they were the one who didn't log in the hours. And yes, we have it in our policy that they are expected to log in anytime they are working, but we also know at times they aren't following the policy.

All it takes is one complaint and you are going to spend thousands of dollars defending yourself, even if you are in the right. While I don't think any of my team members would ever file a complaint, I simply cannot take that risk and put the company at risk, because that could potentially affect the lives of all of our employees.

We hated having to make changes to our "way of doing business." My team hated it because they felt the regulators, such as the Department of Labor, don't get it when it comes to what it takes to grow a business. But in the end, I just didn't get it, and I have to enforce our office policy in order to comply with regulations. I did it with a little bit of kicking and screaming, but no loss of body parts.

The tougher part was getting my team to understand why we had to make the change. They felt robbed of their ability to be responsive, and to go above and beyond to serve; and just didn't like the idea of having to make this change.

Teach Staff (and Yourself) the WIIFM

Since people are inherently resistant to change, we, as owners and leaders, need to make sure we explain the need for change in the right way so our team members can see the WIIFM – the "What's in it for me?" As I reviewed the recommendations of our HR company with them, you could see the negativity coming out rather overtly. As we continued to talk and I explained the why behind the changes, it got better.

I explained that we must be congruent in what we teach and how we run our business. We should focus on working hard while at work and then unplugging when we are at home. Our kids and families should have their time with us and not have to "share us" with the business.

The more we talked, the conversation moved from bashing the regulators to realizing this really is a quality-of-life issue for the team, and that it is in the best interest of the employees, their families and our business to make the necessary changes. They found the WIIFM.

New Year, New (Better) Practice

As the New Year approaches, take a look at your office policies, your financial policies, and your HR and compliance policies. Make a list of those that may need updating or a makeover, and set your goals for a clean slate come Jan. 1, 2017.

As you look at changes in your office policies – changes designed to solidify your practice, minimize your risks and streamline your operations – realize that change is not easy and that it does require open, honest communication with your team. Once that has occurred and you've made sure you've shown them the benefit of making changes, then you follow through.

Dr. Fred Barge wrote a great book titled Are You the Doctor, Doctor? Let me ask: Are you the leader, doctor? If so, it's time to lead your practice and team not just where it is easy to go, but where we need to go to practice with more peace of mind.

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Editor's Note: Email with "Policy" in the subject line to receive a one-page simple financial policy summary from the author to help start this conversation with your practice team.

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Dr. Ray Foxworth is a certified medical compliance specialist and the president of ChiroHealthUSA (www.chirohealthusa.com). A practicing DC, he remains “in the trenches,� facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association and staff chiropractor at the G.V. Sonny Montgomery VA Medical Center.